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Metatarsal Pads and Diabetes

Metatarsal Pads to Reduce Uleration Risk in Diabetic Patients

Several studies have evaluated the use of metatarsal pads in reducing forefoot pressure in patients with diabetes. Hastings et al. evaluated total contact inserts and metatarsal pads in the reduction of peak plantar pressure. The purpose of the study was to determine the effect of metatarsal pad location on peak plantar pressure in subjects with diabetes mellitus and peripheral neuropathy. Compared to the total contact insert alone, researchers found consistent plantar pressure reduction when the metatarsal pad in this study was located between 6 to 11 mm proximal to the metatarsal head line. Pressure reduction was less effective as the metatarsal pad moved outside of this range and pressure actually increased if the pad was located too distal of this range.23  Hsi et al. found that metatarsal pad application decreased maximal peak pressure and the pressure-time integral under the second metatarsal head. In this study teardrop shaped metatarsal pads made of polyurethane foam were used and optimum pressure reduction was found when the pads were placed just proximal to the metatarsal head.24,25

Orthotic Prescription Recommendation: 

  • Topcover: In order to ensure easy access to add, remove or adjust a metatarsal pad, request that the topcover be glued on heel only of the orthosis when first applied.
  • Metatarsal Pad: Metatarsal pads can be added to orthoses at the lab or added by the practitioner in the clinic. Leaving the anterior portion of the topcover unglued makes this process easy.

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